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R OFFICE USE: -- ---- --- -To Permit No. _. �/ APPLICATION FOR SANITATION PERMIT _.._. y/ -1 -_------- (Complete irL.Duplicate) RR Date Issued ----"--------- ---- - --- ----------------- `This Permit Ex ires 1 Year Fro rrl Date Issued ------------- --- --- - ----- --- Application is hereby made-to the San Joaquin uin Local Healt Health for o.e permit to construct and install the work herein described. This application is made in compliance. w Y - ------' ----------------------------- :' � 4w JOB ADDRESS ANQ LOC •C N - __ Ph Owners Name- -, Address----- ......... --- -•---------------- � : t --------- --------------------- -�+.moi'one.. __. Contractor's Name--- _.-_ --•• _ - - i x Mo+el other ❑`. -� Apartment Hou ❑ Trailer Cour# ❑ f# ❑ � Installation will serve: Residence ❑ p 7� s J --------------•- .� Lot s Sze— _ !- Number of livin units - Number of=bedrooms _ Number of-baths - Private-0, Depth.�o Water Table Water Supply: Public systemommun"ity tem❑ Y ;: t Cla l Adobe® ardpan ❑ t Clay.Loam ❑ Y ❑' Character of soil to_a depth of 3 feet: Sand_❑ Gravel ❑ ndy Loam�� y � No FHA/VA: Yes ❑ s No [�— hcation'Ma�le:{If yes,date: -J�)- N-c p New Construction: ,Yes ❑ Previous App i TYPE OF F INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.] } ( P - i oundatio t Se tic dank: Distance from netr6it well-----------------Distance from fn Material -- .--_-_------"- I l/ ; No. of compartments--------.-.L- Size---= ----------Liquid depth---------------- = CapacrtY------ Disposal Field Distance from nearest well.--� ' _ DLeng#h offrom each line at3o -- t------------ - W cif cofttrench....er- 10+ line----,------------- 0 -- - ---- J r Number of lines----------- t --Total length----------------------- i lT"F� ----De th of�ilfer material I---_--- --'-- lf1 . Type of filter material- p Distance to nearest lot lir a---V ---.----- .x' Seepage Pit- Distance to nearest well------r.--- Distance from foundSize:Diameter-- . Depfh_V------------------------ ° Number of sts-.-_I--------------Lining ma#erial----.ej9 �` { i P 1 Cesspool: � Distance from nearest we4l----------------�Distance from foundation_--�---_-_---_-----.Lining mate'ria--._------------------------------------------------- ce from th`_- .-Liquid CapacitY------------------------ gals. N ❑ Size: Diameter-------- ------------ -------------- p -------_-- U.- Dista te.from nearest building_-_---------------------- I Distance from nearest-well -------- i Privy: - ---------- ----------- ------ ( f� Distance to nearest lot line }------ -. ------ -- ;, V -tet' .a2 ----- ;Z I. Remodeling and/or repairing (describe): '-.....'� c. f > t - ---- --------------------------- - r. -----1-- -- '---------- - ----------- -------------------•----- I `---------------------------- -------------------------- -------------------- ---------------------- --------------------------------- ----------- i t s I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun , y ••� ordinances, State !laws, and rules and regulations of the San.Joaquin Local Heal District. { ----- (999,xZA or 0 act (Signed) -------- -- { 9ned - ---- -- - � - --•- - -----(Title)-- �.�,� --' -- ---- �" �- - By:----------------------------------------------------- -------------------------------- (Plot plan, showing size of lot, location of sysfem.in.relaf to wells, buildings, etc., can be placed on rever',,side). g FOR DEPARTMENT USE ONLY t ts" = - DATE-----------z7� `�/----�' f----------- APPLICATION ACCEPTED BY--- DATE-------- ---%C ` ---- ------------------ REVIEWEDBY--------------------------------------------- -- DATE-------------------------------------- ------- -------------- ------- ----- -------- ----- - .5--•"-__ BUILDING PERMIT ISSUED-------------------------------- Alterations and/or rec9mmend�#ions:-------------- �j { EC t / �G' r --'- ----- -------------- ----------------------- ---------- --------------- ----- - -- ---------------- -------•------------------------- r _ -------' ------------------- -----------------------------------' ------------------•---------------------------------------------- f ��'L– Date-. `% L, / ---------------------------------------- FINAL INSPECTION BY ---- --------- ------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maselton Ave. 3o0 West Oak Street �t� r 1'24 Sycamoy Street, 205 West 9Th Street' Stockton,California L.di,'California ��', `� Mpnt ca,Califo nla, ; Tracy,California 1R5 9 nEVISEO 8-59 3M 3•'63 F.p•C C. : . j .